or, by its more formal title:
Grammatical concepts of English: Suggested order of intervention
Have you ever asked the following?
“I know that I still need to work on grammar with older kids with DLD to ensure academic success, but what rationale should I have for selecting targets?”
“How do I decide what order to tackle the many areas of grammar that need support?”
“Is there any evidence to help me decide whether I should work on passives or relative clauses or adverbial clauses first? They all seem important—and hard!”
We're (finally!) ready with some answers. So enjoy:
The following blog and its accompanying spreadsheet were created by Susan Ebbels, SLT, PhD and Amanda Owen Van Horne, PhD, CCC-SLP. Additional content support provided by Karen Evans, MA, CCC-SLP and Hilary Nicoll, BSc, SLT.
SLPs posing questions like this are rightly worried about maximizing academic and functional outcomes for children with DLD in the face of limited evidence to guide target selection for grammatical goals once children reach school-age. As far as we are aware, no systematic studies have yet been completed that show which order of intervention is most effective, no matter how you measure efficacy (most likely to lead to the greatest immediate progress, most likely to lead to the greatest gains through generalization (e.g., Rvachew & Nowak, 2001; Owen Van Horne, Fey, & Curran, 2017)).
Evidence can be inferred WITHIN an area but not ACROSS areas
Within any given area (e.g., Questions), there is typically some preliminary evidence to suggest that some things should be learned before others (e.g., Y/N questions before Wh- questions), but across areas (e.g., Questions vs. Conjoining), there is rarely a clear ordering and two reasonable people (including the authors of this blogpost!) might disagree. Indeed, the same SLP might make different decisions for different children as they consider the impact of each child’s specific difficulties with comprehension or production on their functioning in the classroom, playground, at home or when interacting with the wider community. This depends not only on the child’s profile but also on the topic areas being covered in that child’s class currently and the structures needed to interact successfully with others.
Well, now what? Guessing time? No—because even though the evidence is limited, there’s still plenty of reason to predict that some things logically could or should be taught before others.
And because we know clinicians need some strategies now, we’ve shared our best guess at a likely order of treatment within each of several syntactic domains (main clause structure, noun phrases, negation, questions, adverbials, conjoining, agreement, tense/aspect, complement clauses, passives, relative clauses) in the tables available here:
The first tab of the spreadsheet provides an overview of all the areas covered within each domain of morpho-syntax. If you hover your cursor over an item, you will see a pop-up note with a definition and/or example of that structure. Each column on the first tab then has its own tab (also linked from the column headings), which provides the same order with more details, including more examples of each structure type, any prerequisite structures, and notes about things to consider. In principle, an SLP could start at the top of any given column/tab and work their way down that tab and feel like they have some logical order of prerequisite skills through which they are passing that is either grounded in the typical development literature, or the typical development literature plus our own personal experience teaching children these targets. However, working straight down a single tab alone is unlikely to be the best strategy as areas near the top of most tabs are likely to be more functional and important than areas lower down most other tabs. Thus, switching from one tab to another, or indeed, combining targets across tabs may be the best approach.
What the color-coding means: The purpose of the colors is to aid decisions about how to order or combine across tabs, though we view these color-coded divisions as somewhat more disputable.
For example, an SLP working on amber areas of tense and aspect (e.g., is+VERB+ing) might want to teach grammatically correct who and what questions (also amber, who/what is VERBing?) before teaching third person singular -s (green) or perfect tense (green). Some areas, like adverbial (e.g., he fell BECAUSE she tripped him), or complement clauses (e.g., he thought she tripped him on purpose), are often thought of as late developing, but in fact are present in very young typically developing children’s speech and thus are also coded amber. Other elements within the same column may be primarily observed in literate language (e.g., thus, nevertheless, although). Thus, we would encourage an SLP to not just proceed in lockstep down any individual column/tab, but rather to consider what else of that same color might need to be taught looking across the other columns/tabs before proceeding across color boundaries.
Some precursor skills may be required or may help link two areas
In some cases, we can say that children must master certain precursor skills before being able to attempt a particular target (e.g., auxiliaries and copulas before Y/N Questions) because logically you need to be able to say am, is, or are before you can say Is she running? or Are you happy?. Similarly, being able to use a wh-question word meaningfully by itself (Where?) may precede being able to use that wh-question word in a well-formed question; or understanding and use of temporal adverbs (before, after) ought to precede work on temporal adverbial clauses (before we eat dessert, we should eat dinner). In the more detailed tabs for each area, in addition to listing targets in a logical sequence we also indicate when a skill from another tab is required to be successful. Occasionally we indicate the need for semantic or conceptual foundations (e.g., time concepts before tense), though there is a need to attend to conceptual underpinnings in general. We have tried to differentiate between REQUIRED precursors and recommended ones, though we note that this is based on logic, our own clinical experience, or intuition rather than empirical research evidence.
Remember: If you identify a target you’d like to work on, also check out its prerequisites. These are its logical precursors.
Consider targeting academically relevant syntax even if morphology isn’t yet perfected
Though it is common to work on pronoun case and verb morphology prior to working on compound and complex sentences, there may be reasons to move on to other targets prior to mastery. Examination of Brown’s stages shows that typical children are advancing their use of complement clauses and coordinated/adverbial clauses while still making errors in tense and agreement (Brown, 1973). Tense and agreement can show a particularly protracted course of development in children with DLD (Rice, Wexler, & Herschberger, 1998), even with intervention (Rice, Hoffman, & Wexler, 2009).
Thus one might want to target improved use of verb morphemes while also targeting syntactic goals such as the use of complement clauses (also called nominal clauses). For example, “mom said she put my homework in my folder” might be a critical thing to communicate and could be successfully communicated even if morphology is in error as long as embedding is intact (e.g., Mom say her put my homework here (points to folder)). Expressing cause-effect (me angry because he push me), if-then (if lunch money at home, you be hungry), before-after (before go school, I lose jacket), what someone said (Sally asked I come her house after school), thought (I think we go today), desired (I hope we play together) or perceived (I see her car gone and no one at home) all require using embedded clauses and are critical for developing relationships and understanding school culture.
Teaching clause structure alongside morphology can help ensure that kids can communicate ideas associated with false belief (I thought…. but...) or reported speech (she said that...) (Durrleman & Delage, 2020) or introduce strategies for clause combining to allow conditional (If-then) or causal (because, so) concepts to be communicated. Two strategies exist:
Comprehension is at least as important as production
Successful interaction with others and access to the curriculum in the classroom depends both on being able to understand what others say or write and being able to clearly express yourself in speech and writing. We cannot assume that children who produce certain grammatical structures can also fully understand them. They may be producing strings of words they have previously heard without full understanding of the structure. Many children use context to help their comprehension, but when this is removed or limited, comprehension may break down. So, a child being quizzed by a teacher may not understand the difference between did you push Pete? and did Pete push you? leading to confusion about who was the guilty party.
It is vital that SLPs check children’s comprehension and production. Factors that support production may be different than the factors that support comprehension. Nonetheless, when working on a particular area of grammar it may be most efficient and effective to work on both comprehension and production together. For example, the SLP says a target sentence (e.g., the cow is pushing the horse) and the child acts it out with toy figures and then the child produces another sentence using the same structure (e.g., the cat is chasing the dog) and the SLP acts it out. This reinforces the meaning of the structure, the importance of the word order and works on both comprehension and production together. Indeed, a final stage may be for the SLP to deliberately “make errors” in their comprehension and production to see if the child can spot these errors, with the eventual aim of the child being able to spot their own errors and self-correct them. In the detailed tabs, we especially call attention to places where comprehension is likely to lag behind production or require special attention.
Generalization across structures is limited
We also know that kids with DLD show limited generalization across structures. In work with young children using recasting as the therapy technique, Wilcox and Leonard (1978), for instance, showed that children learn each wh-word plus auxiliary combination individually and Curran and Owen Van Horne (2019) found that preschool and kindergarten children learned because adverbial clauses but did not generalize to other types of causal adverbial clauses. Explicit instruction or intervention with older children may result in generalization within structures more than the implicit approaches frequently used with younger children. Tools like visual cues (as are employed in the SHAPE CODING™ system) highlight how grammatical forms are similar and serve similar functions within the sentence frame, which may lead to better generalization to items with the same (Ebbels, van der Lely & Dockrell, 2007) or similar structures (Tobin & Ebbels, 2019). Nonetheless, ensure that a child has learned all aspects of a new structure before marking it as mastered.
Focus on functional implications and be flexible!
This blog post and the linked tables were constructed in response to questions about working with school-age kids with DLD, but we have ultimately provided a broader view of interlocking goals in the area of grammar and syntax. Knowing what to target for school-age children can be difficult because they have made good progress on many of the ‘basics’ and now need support to master the nuances of literate and academic language. These aspects of grammar are areas even experienced SLPs may feel unsure of and need to brush up on in order to provide best supports. Ongoing efforts to support SLP metalinguistic awareness, knowledge and confidence of interventions in these areas are available through SHAPE CODING™ program.
Each area is likely to require concentrated intervention in order to see sustained progress that is maintained over time. This is effortful and some structures may never be targets for some children due to the need to address competing priorities such as vocabulary or pragmatics. Clinicians should set intervention priorities based on functional impact linked to the child’s age and ability level and continuously revise these goals in consultation with the child, their parents, and their teachers. An adolescent or young adult may need the ability to engage with written language in academic texts, job contracts, and civil discourse. A younger child may need the oral language of the classroom and the playground the most. This is not to say that a younger child does not need access to complex syntax, however (Curran, 2020) or that an older child does not need to revisit tense and agreement (Nippold, Nehls-Lowe, & Lee, 2020). An SLP should feel empowered to move beyond the order set forth in these tables in order to flexibly match the order of intervention to the particular functional needs of the individual young person and to educate others about the importance of different aspects of grammar and syntax for academic and professional success.
NOTE: This spreadsheet is for the English language. But what about the various dialects of English? Will everything hold up, regardless of dialect? Blog author Dr. Amanda Owen Van Horne and our topic area expert, Dr. Kyomi Gregory, provide a little further discussion on that in the comments section, below.
Ebbels, S., & Owen Van Horne, A. (2020). Grammatical concepts of English: Suggested order of intervention. The Informed SLP. https://www.theinformedslp.com/how-to/grammar-chart
Authors of this blog post were paid for their contribution.
The SHAPE CODING™ program, mentioned above, was created by author Susan Ebbels and her employer, Moor House School & College, receives financial compensation from training and resources.
Brown, R. (1973). A First Language: The Early Stages. Harvard University Press.
Curran, M. (2020). Complex sentences in an elementary science curriculum: A research note. Language, Speech, and Hearing Services in Schools, 51(2), 329–335.
Curran, M., & Owen Van Horne, A. (2019). Use of Recast Intervention to Teach Causal Adverbials to Young Children With Developmental Language Disorder Within a Science Curriculum: A Single Case Design Study. American Journal of Speech-Language Pathology, 28(2), 430–447.
Durrleman, S., & Delage, H. (2020). Training Complements for Belief Reasoning in Developmental Language Disorder. Journal of Speech, Language, and Hearing Research, 1–17.
Ebbels, S.H., van der Lely, H.K.J., and Dockrell, J.E. (2007). Intervention for verb argument structure in children with persistent SLI: a randomized control trial. Journal of Speech Language and Hearing Research, 50, 1330–1349.
Owen Van Horne, A. J., Fey, M., & Curran, M. (2017). Do the hard things first: A randomized controlled trial testing the effects of exemplar selection on generalization following therapy for grammatical morphology. Journal of Speech, Language, and Hearing Research, 60(9), 2569–2588.
Nippold, M. A., Nehls-Lowe, A., & Lee, D. (2020). Development of Past Tense Counterfactual Sentences: Examining Production and Comprehension in Adolescents and Adults. Journal of Speech, Language, and Hearing Research, 63(3), 764–773.
Rice, M. L., Hoffman, L., & Wexler, K. (2009). Judgments of Omitted BE and DO in Questions as Extended Finiteness Clinical Markers of Specific Language Impairment (SLI) to 15 Years: A Study of Growth and Asymptote. Journal of Speech, Language, and Hearing Research, 52, 1417–1433.
Rice, M. L., Wexler, K., & Hershberger, S. (1998). Tense over time: The longitudinal course of tense acquisition in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 41(6), 1412–1431.
Rvachew, S., & Nowak, M. (2001). The effect of target-selection strategy on phonological learning. Journal of Speech, Language, and Hearing Research, 44(3), 610.
Tobin, L. M., & Ebbels, S. H. (2019). Effectiveness of intervention with visual templates targeting tense and plural agreement in copula and auxiliary structures in school-aged children with complex needs: a pilot study. Clinical Linguistics & Phonetics, 33(1-2), 175–190.
Wilcox, M. J., & Leonard, L. B. (1978). Experimental acquisition of wh-questions in language-disordered children. Journal of Speech and Hearing Research, 21(2), 220–239.
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